Provider Demographics
NPI:1417946740
Name:HALLER, PATRICIA A (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:HALLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 EXECUTIVE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8087
Mailing Address - Country:US
Mailing Address - Phone:740-774-4616
Mailing Address - Fax:740-779-3856
Practice Address - Street 1:59 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3104
Practice Address - Country:US
Practice Address - Phone:740-774-4616
Practice Address - Fax:740-779-3856
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4841152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311745571OtherCOORDINATED VISION CARE
OH4042081OtherMEDICARE
OH311745571OtherVISION PLUS
OH0005791631OtherAETNA MEDICARE
OH2201034OtherUNITED HEALTHCARE
OH2013921Medicaid
OH311745571OtherVISION SERVICE PLAN
OH0005791631OtherAETNA MEDICARE
OH4042081OtherMEDICARE
OH311745571OtherVISION PLUS
OH4224711Medicare PIN